Repealing health-care reform would cost hundreds of billions of dollars -- and Eric Cantor knows it

By
Ezra Klein

House Republicans are in a pickle: One of their new rules says that new legislation must be paid for. But the health-care bill reduces the federal deficit by more than $100 billion over the next 10 years. Luckily, they've figured out an answer to their problem: They've decided to simply exempt the repeal bill from the rules. That means they're beginning the 112th Congress by lifting their own rules in order to take a vote that will increase the deficit. Change we can believe in, and all that.

Republicans are aware that this looks, well, horrible. So they're trying to explain why their decision to lift the rule requiring fiscal responsibility is actually fiscally responsible. Majority Leader Eric Cantor got asked about this, and he returned the reporter's serve with a volley of nonsense. "About the budget implications, I think most people understand that the CBO did the job it was asked to do by the then-Democrat majority, and it was really comparing apples to oranges,” Cantor said. “It talked about 10 years' worth of tax hikes and six years' worth of benefits. Everyone knows beyond the 10-year window, this bill has the potential to bankrupt this federal government as well as the states."

That's all well and good -- but it's not true. Take Cantor's core point: The health-care reform bill includes "10 years' worth of tax hikes and six years' worth of benefits." There's nothing philosophical about this statement. It can be checked with a simple look at the spending tables the Congressional Budget Office published in their analysis of the bill. And when you look at those tables, Cantor's statement falls apart:

Roughly speaking, new spending is what counts as "benefits." Those are the lines shooting up. New taxes are the lighter blue part of bars pointing down. In years one, two, and three, new benefits are larger than or matched with new taxes. In year four, that's not true, but the difference is fairly small. And in the six years after that, even Cantor admits the benefits match or overwhelm the taxes.

So as an empirical matter, what Cantor is saying just isn't true. But just for the record, it's also wrong as a theoretical matter: Comparing 10 years of saving and working with six years of spending is not comparing apples to oranges. Parents will routinely work harder (revenue increases) and save more (spending cuts) for decades in order to help their children pay for college. That's 18 years of raising revenues and cutting costs in return for four years of spending on benefits. An accountant wouldn't look at that and say he couldn't assess the wisdom of the decision because it's apples-to-oranges. An accountant would happily note that that's how you pay for things when you're being responsible. Cantor's party might be out of practice on that, given the way they paid -- or, to be more specific, didn't pay -- for the Medicare Prescription Drug Benefit, but it doesn't make it any less true.

As for the period "beyond the 10-year window," the Congressional Budget Office -- which is now comparing "apples to apples," as the law is delivering full benefits for all 10 of the next 10 years -- says the law saves vastly more money in its second decade: "The legislation will reduce federal deficits during the decade beyond the 10-year budget window relative to those projected under current law—with a total effect in a broad range around one-half percent of GDP." That's in the neighborhood of a trillion dollars.

What's important about Cantor's argument is not that he's wrong. It's why he's saying something he knows to be wrong. There are plenty of reasons to oppose the health-care reform bill. You might not want to spend that money insuring people, or you might not think the legislation goes far enough in reforming the system. But as a matter of arithmetic, using the math that Congress always uses, the bill saves money. It cuts enough spending and raises enough taxes to more than pay for itself, both in the first 10 years and in the second 10 years. In fact, Democrats added that second metric, which is not typically a hoop that legislation has to jump through, in order to specifically allay concerns that the legislation would backload its costs. Instead, as CBO said, it ramps up its savings.

But Cantor and the GOP know full well that the bill is unpopular largely because people think it increases the deficit. Polls have shown that only 15 percent of Americans know that CBO said it will reduce the deficit. If, in the repeal fight, it becomes widely understood that the bill reduces the deficit, it will become more popular. So it's crucial, as the repeal effort goes forward, for Republicans to become much more brazen in falsely asserting that the bill doesn't really reduce the deficit, and that even if the CBO does say it reduces the deficit, that they're saying that because they've been tricked somehow. But CBO wasn't tricked. If it were, Cantor, who has a staff dedicated to figuring these things out, would have a better argument than the one he's offering.

Forget to increse the deficit by 200 billion (minimum) reflecting the Congress' inability to reduce Medicare reimbursement rates? A little late to say that the Medicare money which will be shifed to Medicaid funding to pay for the health care bill is not part of the Health care bill.

Other issues are present making the CBO assumption of future savings a bit questionable.

Too bad Dems don't have the bully pulpit of the presidency in order to fully educate the American people on the fiscal soundness of HCR. Oh wait...they do. Obama may be the worst presidential communicator ever.

Wow Cantor's remarks about the CBO are earth shaking. He effectively says you must take the CBO estimates and factor in the political party in power. Then somehow you'll be able to learn the full truth and cost of legislation and future impacts. He's full of political S*** and needs to be held accountable for his comments.
Future GOP legislation using the Democratic CBO according to him is "apples and oranges"

Anyone with a head for numbers that isn't rooted in liberal spin can tell you the CBO numbers are fictional. The real cost is far, far, far beyond CBO spin.
If anyone wonders why newspapers are in decline just read the space given to journalist who insist on reporting to their political bent.

Anyone with a head for numbers that isn't rooted in liberal spin can tell you the CBO numbers are fictional. The real cost is far, far, far beyond CBO spin.
If anyone wonders why newspapers are in decline just read the space given to journalist who insist on reporting to their political bent.

they're not ficitional. They actual numbers but what kidvid doesn't seem to grasp (or doesn't want to) and Ezra doesn't MENTION is that the CBO will give numbers based upon the perameters set forth. The data coming out is only as good as the data going in. Oh and they conveniently forget about the CLASS Act and the new entitlement those premiums taken in THERE to pay for the PPACA but yet not funding that entitlement on the way out.

And Ezra forgets that the repeal fight is only to appease the right wing base. Ezra seems to speaking here like he expects it to go anywhere outside the House. It obviuosly won't.

oh and btw, it shouldn't be repealed but it SHOULD be fixed. You know to address cost that's skyrocketing but it won't because neither party has the stones to take on the medical establishment.

Out of the gate lying through their teeth. Thet are counting on fux the news to relentlessly repeat this lie, they are counting on the fact that most Americans have no idea what a "CBO" is, and they are counting on what most reporters do - which is simply write the lie without bothering to do a simple and basic fact check.

The title of the article talks about hundreds (note the plural) of billions of dollars, yet the CBO projection says hundred (note the singular) billion. So Mr. Klein sensationalizes the issue by projecting on his own, without any basis.

In any case, if you believe that we will achieve a savings of ten billion dollars per year with all the new coverages, and now no compulsory buying of insurance, I have a nice bridge for sale at a very favorable price.

Undoing ObamaCare would cost much less than continuing with it. And, The country would finally have the chance to have a national health care law that would actually improve health care services and reduce costs.

"and that even if the CBO does say it reduces the deficit, that they're saying that because they've been tricked somehow. But CBO wasn't tricked."

John Cassidy of the New Yorker has a pretty good argument about why the CBO numbers aren't likely to hold up. It's less about being "tricked" than it is about overly optimistic assumptions about businesses not changing their behavior in response to the subsidies the government is offering.

"The question of what impact the reforms will have on existing insurance plans has received even less analysis. According to President Obama, if you have coverage you like you can keep it, and that’s that. For the majority of workers, this will undoubtedly be true, at least in the short term, but in some parts of the economy, particularly industries that pay low and moderate wages, the presence of such generous subsidies for individual coverage is bound to affect behavior eventually. To suggest this won’t happen is to say economic incentives don’t matter.

Take a medium-sized firm that employs a hundred people earning $40,000 each—a private security firm based in Atlanta, say—and currently offers them health-care insurance worth $10,000 a year, of which the employees pay $2,500. This employer’s annual health-care costs are $750,000 (a hundred times $7,500). In the reformed system, the firm’s workers, if they didn’t have insurance, would be eligible for generous subsidies to buy private insurance. For example, a married forty-year-old security guard whose wife stayed home to raise two kids could enroll in a non-group plan for less than $1,400 a year, according to the Kaiser Health Reform Subsidy Calculator. (The subsidy from the government would be $8,058.)

In a situation like this, the firm has a strong financial incentive to junk its group coverage and dump its workers onto the taxpayer-subsidized plan. Under the new law, firms with more than fifty workers that don’t offer coverage would have to pay an annual fine of $2,000 for every worker they employ, excepting the first thirty. In this case, the security firm would incur a fine of $140,000 (seventy times two), but it would save $610,000 a year on health-care costs. If you owned this firm, what would you do? Unless you are unusually public spirited, you would take advantage of the free money that the government is giving out. Since your employees would see their own health-care contributions fall by more than $1,100 a year, or almost half, they would be unlikely to complain. And even if they did, you would be saving so much money you afford to buy their agreement with a pay raise of, say, $2,000 a year, and still come out well ahead."

"The designers of health-care reform and the C.B.O. are aware of this problem, but, in my view, they have greatly underestimated it."

Since the health bill also includes provisions that force the consumer to have and pay for coverage not necessary, how many billions are are coming from the consumers' pocket for increased premiums??Case in point: all routine exams and diagnostic tests are no longer subject to deductibles or copayments. Sounds great right??? My premium just increased 35% on my individual health plan since the insurer was forced to add this coverage to my original plan. My annual premiums have now jumped an additional $1600 per year so I can pay for coverage that I never wanted. The unintended consequences of the Democrats stupidity...

Too bad Dems don't have the bully pulpit of the presidency in order to fully educate the American people on the fiscal soundness of HCR. Oh wait...they do. Obama may be the worst presidential communicator ever.

Posted by: rich_in_nj
=============================================
He did so badly handing the entire GOP house their heads in their health care debate, FOXNEWS cancelled their coverage. Obama foolishly gave up the public option thinking compromise would come from the GOP, which is why 13% of progressives don't approve of the bill feeling it is too weak.

What do you figure the chances are that 10% of the electorate can understand any of this?

That's why poor white people vote for Republicans and people like Sarah Palin are taken seriously as presidential candidates: the issues are too complex for more than an handful of voters to grasp them.

Undoing ObamaCare would cost much less than continuing with it. And, The country would finally have the chance to have a national health care law that would actually improve health care services and reduce costs.

Posted by: mike85
=============================================
Repeal and replace is Cantor's mantra. The GOP has given us millions of words about repeal, not one about replace. Tort reform being the answer to our health care problems is ludicrous. Slogans are easy, governing very hard, when will the GOP produce some bills for the latter?

--*Parents will routinely work harder (revenue increases) and save more (spending cuts) for decades in order to help their children pay for college.*--

Yes, but they won't do the same for other people's children, nor will many of them make the effort if they think other people will pay for their children with no penalty for the inaction.

And at the end of paying for a college education, the saving and scrimping stops, and there's a tangible benefit. Under DeathCare, the scrimping and paying goes on forever (at least for those who insist on earning their own way even as the state helps itself to more and more of the fruits of that activity.)

while that's a great example you give from experience you're severely underestimating what the actual cost of a healthcare plan for a random 100 employees are in your example below.

"Take a medium-sized firm that employs a hundred people earning $40,000 each—a private security firm based in Atlanta, say—and currently offers them health-care insurance worth $10,000 a year, of which the employees pay $2,500. This employer’s annual health-care costs are $750,000 (a hundred times $7,500).

I'd expect the figure is closer to $1.5 million or greater depending on where in the country they're located. But again that just further makes your point.

nay, it would keep the low hanging revenue fruit for the deficit and debt, and free business to hire from the rigid ideological interference in one of their biggest costs. i suspect this momentum for repeal and the certainty now with the new GOP congress of a blunting obamacare's full effect will help the economy in a way that the passe of obamacare did not. the next jobs report will be VERY telling.

The Democrats need to upgrade their communications game. The Republicans badly beat them in 2010 and so far are off to a good start in 2011. Why can't the Democrats just keep reciting the 20 or so things the health care bill already is doing and go from there? Why are the Democrats so lame at the communications game?

I really do not care about the expense of the new health care bill. I thing it is worth getting rid of a few bomers to save the lives of those without the means to see a doctor. OMG is that socialized medicine. So be it.

And Ezra forgets that the repeal fight is only to appease the right wing base. Ezra seems to speaking here like he expects it to go anywhere outside the House. It obviuosly won't. My boyfriend thinks the same as I do. He is eight years older than me, lol. We met online at agegaplove.c``om a nice and free place for younger women and
older men, or older women and younger men, to interact with each other. Maybe you wanna check out or tell your friends.

Politicians who sale every Tax Cut is paid back by growth are simply going one step further here...

What is shameful is Obama in his zeal to curry favor with GOP:
- not only drops the 'end of life' regulation back;
- but is simply allowing all this non-sense and lies to spread further about Health Care Law.

It is as sickening as like how Obama kept on criticizing Health Insurance companies beyond a point when he should have been focusing more and more on 'provider cost'.

Obama's obduracy here reminds how senselessly and blatantly Bush/Cheney kept on deceiving America when they continued to justify Iraq war as fighting Al-Qeda in Mesopotamia to save terrorism at home.

We know how it ends after few years. Like Cantor, Obama equally knows all these lies which are floating around and how GOP is spreading that. But he will not lift his fingers. He is party to this 'murder of Truth'.

What he has learned is as long as he keeps quiet and throw out his own 'babies out of bath tub'; whenever he 'sleeps' with GOP; fruits of that labor will be conceived.

He is not taking a correct stand like - let us improve the existing act and not throw out what we got correct there. Rather, he will keep on giving piece by piece each component of the passed Law and will trade for 'so called peace' with GOP. Causality of Truth and core interests of Americans; that is just collateral damage.

And Ezra forgets that the repeal fight is only to appease the right wing base. Ezra seems to speaking here like he expects it to go anywhere outside the House. It obviuosly won't. My boyfriend thinks the same as I do. He is eight years older than me, lol. We met online at agegaplove.c``om a nice and free place for younger women and
older men, or older women and younger men, to interact with each other. Maybe you wanna check out or tell your friends.

Klein's numbers game in claiming that the health care bill will reduce the deficit are phony. Basically, the bill has 10 years of taxation, but only six years of benefits. On a year-to-year calculation, the health care bill will not pay for itself. It only manages to reduce the deficit during the first 10 years because it collects new taxes for four years before it actually has to start paying out money.

The idea that the repeal of a bill "costs" money is also a bit sketchy. The bill costs American taxpayers money, and it's paid for through higher taxes. Repealing the bill would eliminate these new taxes. Does eliminating taxes "cost" taxpayers money? No. It may leave a hole in the federal budget, assuming spending is not also cut, but Democrats were essentially banking on four years of tax increases before any costs began to mount to make it look like the health care bill was budget neutral. That was a massive fib, and so repealing the bill doesn't actually cost us anything. It just takes us back to where we were and avoids huge tax hikes that would have smothered taxpayers.

Anyone with a head for numbers that isn't rooted in liberal spin can tell you the CBO numbers are fictional. The real cost is far, far, far beyond CBO spin.
If anyone wonders why newspapers are in decline just read the space given to journalist who insist on reporting to their political bent.

Love the "number have a liberal bias" quip!

==============================================

Anyone with a head for logic that isn't rooted in conservative spin, can tell you that your statement is simply ridiculous.

The CBO numbers don't support your point of view???? Ignore them and call them politically motivated.

Since you said it, it must be true.

The problem is, the CBO has all these irritating 'words' and 'numbers' to back up their report.

There is a series of bad incentives in the bill which will grow over time, and which will increase costs more than expected.

As health care costs grow:

- The relative strength of the mandate will be reduced, increasing the incentive for the healthy not to buy coverage until they are sick

- The incentive for employers to drop coverage, and pushing their employees into subsidized pools will rise

- The implicit marginal tax of the withdrawal of subsidies - particularly severe at the 400% FPL cutoff - will lead people near that cut off to reduce their income in order to get the subsidies, at the same time reducing tax revenue and increasing expenses

- The people who do gain coverage or just receive better coverage will have increased cost insulation, which will drive demand and prices up for health services

Attempts to squeeze providers could backfire by reducing the long run supply of health services, reducing access to care regardless of insured status (e.g. more potential doctors decide to become investment bankers). Some parts of the bill actually squeeze supply directly, per msoja's link yesterday on physician owned hospitals.

On another note, income inequality will increase, in particular between the lower and upper middle classes. It won't make a whole lot of sense to be at 400%-500% of the FPL. People who in that range will have a strong and growing incentive to earn 399% of the FPL instead, depopulating that income space.

The dirty little secret is that despite Obama's protestations to the contrary the ACA is designed precisely to accelerate the fragmentation of the employer-based system. I actually support this as a matter of policy; taxpayers are already subsidizing middle-class coverage through the employer tax exclusion to the tune of 300 billion dollars a year, for no apparent reason. Unloading employees into a free-market exchange exposes them to the true cost of care, and subsidies would be structured more rationally. The idea is that tax dollars retrieved from unraveling the distortions caused by the exclusion would more than offset the costs of income-tiered subsidy.

The CBO numbers will be upheld if BOTH parties try to work together to make it so.

If the GOP sabotages the law though, then debt will soar.

All you naysayers here are what's wrong with the country. You keep letting your petty ideology interfere with your common sense.

You are all foolish enough to believe the system we had before is better than the changes being attempted and can't see through your stubbornness that now that we've got ACCESS largely solved, we are one step away from solving COSTS. Going backwards means we'd need to solve both problems again and it would guarantee they would nit get solved for many decades, if ever.

You all are on the wrong side of history, just like the anti-abolitionists, or the pro-hitlers, or the loyalists, or the pro-Iraq-war mongers.

Your efforts to aide the nihilists and saboteurs will not go well with God.

This comment thread is indicative of the core problem. You can do all the objective analysis and projections you want, and the frothing right will just stamp their feet and say "Nuh-uh cuz LIBRULZ!" Anyone who deems this objective analysis credible is simply dismissed as part of the conspiracy.

If Ezra was an honest wonk instead of a liberal propagandist, he would dig up the projections of what the government thought that medicare was going to cost when it was initially enacted and graph it alongside of what it actually has cost. The original projections were an order of magnitude too low. Does anyone really think that the bureaucrats have gotten better at making 10 year predictions?

The actual GOP solution for health costs is to allow the worst coverage to be bought for the higest cost. There would also be some kind of tax break that would amount to the rich getting all of the breaks.

IF Obamacare does in fact reduce cost it will only be because of a lowered standard of healthcare and rationing when there are not enough doctors and healthcare professionals to provide adequate care on demand.

your repetition of that lie in response to a post directly debunking it makes little sense.

when liberals point out that in each specific year from 2018 through at least 2029 (CBA was requested to examine the next two decades instead of the usual one for PPACA) PPACA reduces the deficit, you are supposed to blather about constitutionality, freedom, or perhaps mumble something about CLASS.

Eric Cantor is the absolutely worst public servant in the history of the United States. Bar none. He is smart, but he only uses his intelligence to lie to the American people, in order for more money to flow into his re-election campaign coffers; and in order to keep his job. He is the symbol of what is so wrong with our political system today.

while that's a great example you give from experience you're severely underestimating what the actual cost of a healthcare plan for a random 100 employees are in your example below.

"Take a medium-sized firm that employs a hundred people earning $40,000 each—a private security firm based in Atlanta, say—and currently offers them health-care insurance worth $10,000 a year, of which the employees pay $2,500. This employer’s annual health-care costs are $750,000 (a hundred times $7,500).

I'd expect the figure is closer to $1.5 million or greater depending on where in the country they're located. But again that just further makes your point."

I was just quoting from the New Yorker article by John Cassidy, which I highly recommend everyone read as a counterpoint to Ezra's take.

More fundamentally, I don't believe that the following three things can all occur with the new Health Care Law:

Something has to give. Ezra has been relatively clear that he would like to see #3 give through "squeezing providers".

I tend to believe that centralized regulatory structures like the Medicare Payment Advisory Board which the law builds on are likely to be captured by those they are supposed to regulate due to the effectiveness of lobbyists and the amount of money at stake. That is why I would prefer a decentralized market based solution such as Paul Ryan's plan or Wyden-Bennett over the current health care law.

From a guy (Klein)that does not understand the Constitution.... now this .."it will cost billions" - Guess what! It has already cost the economy billions in wasted BS and it is just taking effect. Please, Wapo get rid of this guy and find someone who can actually think like someone with common sense and can analyze facts, not just government propaganda...

The actual GOP solution for health costs is to allow the worst coverage to be bought for the higest cost. There would also be some kind of tax break that would amount to the rich getting all of the breaks.

"Unloading employees into a free-market exchange exposes them to the true cost of care, and subsidies would be structured more rationally."

belegoster,

Only if they earn more than 400% of the FPL. If they earn less - and that's ~$90,000 for a family of four - their cost is capped as a percentage of income, meaning that cost insulation grows over time. A subsidized family earning $85,000/yr will pay $8,075 for health insurance no matter whether premiums are $10,000, $20,000 or $30,000.

A company which primarily employs lower wage workers will drop health insurance. However, companies which tend to employ more affluent workers will probably continue to offer coverage, because these workers won't be elligible for the subsidies and competitive labor market forces will make it difficult for these companies from dropping coverage.

Firms with a mix of coverage will probably try to get around dropping health insurance for lower wage employees by switching them to part time status, or they might even just eat the penalties. I'm not sure of the precise dynamics, but we can be sure that employers will try and probably succeed at gaming the system to their maximum benefit.

"taxpayers are already subsidizing middle-class coverage through the employer tax exclusion to the tune of 300 billion dollars a year, for no apparent reason"

The exclusion for health insurance in 2008 was just $131 billion. It's technically not a subsidy either - failing to take my income does not in any way subsidize me anymore than a thief leaving $1 in my wallet is subsidizing me - even if he protests that he has to take $1 from someone else as an offset.

Come on! Everyone knows the voodo economics such as taking the Doc Fix off budget i.e. $250B plus, along with collecting 10 years of premiums for 6 years of coverage, blow a huge hole in this fantacy!!!

@belegoster"The idea is that tax dollars retrieved from unraveling the distortions caused by the exclusion would more than offset the costs of income-tiered subsidy."

This might be true if you were just talking about the same fixed pool of people who already have insurance through their employeres, however the ACA also increases the pool of insured people at the same time. Given that many if not most of the new people going into the pool are those who previously were uninsurable due to pre-existing conditions and will therefore have higher health care costs on average, it's unrealistic to expect that the expanded coverage will somehow cost less.

Sure, Eric jumped the Democrat reservation but that's not a sin ~ it's just smart in this day and age.

BTW, Chicago, like the State of California, and the New York Metropolitan area just recently found themselves without any "majority" representation. Not likely there'll be any bailouts for those ol'boys now is there.

See, somebody has to be a Republican. I'm one. Eric is one. You're not.

Anyone with a head for numbers that isn't rooted in liberal spin can tell you the CBO numbers are fictional. The real cost is far, far, far beyond CBO spin.
If anyone wonders why newspapers are in decline just read the space given to journalist who insist on reporting to their political bent.

Love the "number have a liberal bias" quip!

Posted by: Lynne51
*****************************************************
Since you have obviously run the numbers yourself, why don't you educate us by showing your work. Until you post YOUR analysis, we'll rely on the CBO numbers.

We have already known Republigoons are stupid in math ("tax cuts pay for themselves!") for the past 30 years. And Cantor is one of the biggest lying schmos there is in Congress. A prissy little at that!

"when liberals point out that in each specific year from 2018 through at least 2029 (CBA was requested to examine the next two decades instead of the usual one for PPACA) PPACA reduces the deficit, you are supposed to blather about constitutionality, freedom, or perhaps mumble something about CLASS."

Eggnogfool,

I think the appropriate conservative retort is that the Medicare projections in the mid 1960s for 1990 missed the actual 1990 numbers by a factor of 10, thus casting doubt on the ability of bureaucrats to predict what costs will be decades in the future.

On the "higher than expected" cost side, you have all sorts of bad incentives pushing in that direction.

The liberals hope that politicians and bureaucrats are able to enact and maintain politically unpopular policies to offset those bad incentives and the general trend of excess cost inflation which existed prior to the (new) bad incentives.

I'd argue that most of the medicare projection issues were due to an unforeseen societal change in terms of the size of the healthcare industry; from about 5% of the GDP in 1960 to about 17% today. and this change wasn't led by the new programs, it was driven by private employer pools, in turn encouraged to overspend on health care by the tax exempt status of employer provided healthcare.

I find the likelihood of the GDP fraction of healthcare more than tripling again (to what, 60%?) unlikely. It should go up in the near future, as the boomers retire (the first boomers signed up for medicare this past monday. hooray!). but this is a factor that will challenge medicare (in its fairly unaltered incarnation), not the reforms involved in Obamacare.

"However, companies which tend to employ more affluent workers will probably continue to offer coverage, because these workers won't be eligible for the subsidies and competitive labor market forces will make it difficult for these companies from dropping coverage." Not when the excise tax kicks in, which exposes hitherto shielded income dollars to taxation. The success of ACA depends on this one key lynchpin--if lawmakers lose their nerves and repeal this then I agree the whole system falls apart.

"If the tax exclusion subsidy is greater than the income-tiered subsidy as you imply, the company will stick with the tax exclusion subsidy." We are talking about two different groups of people (and subsidies): a company may reduce coverage because of its tax treatment independently of subsidies available on the exchange. In effect, it is more or less a subsidy transfer (the horror!) from middle income to poor, such that they are more in line with the rest of the (progressive) tax code.

@jnc4p,

You're absolutely right. The upper middle income will probably see their premiums increase as a result of subsidy transfer to finance the expanded coverage.

The way I see it is that America is already stuck in a system of full coverage-- if not through insurance then through prohibition of emergency visit denials-- the ACA merely rationalizes out the tax treatment supporting this system. Wyden-Bennett and Ryan-Rivlin look nice on paper but are far more radical than what's on the table.

Disclosure: I'm actually from Singapore, and I realize that conservatives love my country's health system because every individual is fully accountable for his or her own costs through mandatory HSAs and copays while insurance is really insurance: securing coverage only against unpredictable events (and not for say, routine office visits). I get that. But provider price controls by government fiat are also a big factor in the low costs enjoyed by everyone--utilization of private services is really marginal at the level of high-end care (except for aesthetics), and provider access is funneled through a nationalized managed-care system that by my reckoning a lot of Americans hate. Payment reform is not the whole picture.

The best way to offset the hundreds of billion dollars in PPACA repeal costs, is to adjust the Medicare S.G.R. (sustainable growth rate) formula by amending the 1997 Balanced Budget Act. The considerable savings already provided by the S.G.R. should be increased to offset the PPACA repeal costs. And, for the years beyond the ten year window (and just to be safe), the savings should be increased by even more.

Now this approach has weaknesses and strengths, minuses and pluses. On the minus side, for example, doesn’t Congress regularly ignore the S.G.R. with its Doc-Fix? This matter should be seriously debated, but at another time. Also, some might argue that this alters the intent and meaning of the S.G.R. But, the S.G.R. was written over 10 years ago. Its meaning evolves even as we disregard it.

On the plus side, this approach has the benefit of being consistent with the PPACA in both structure and spirit.

It uses the same formula to drive significant cost savings, only now the cost savings grow. And, it treats budget accounting with the sincerity and resolve that we have come to expect out of our Congress.

@belegoster
"the ACA merely rationalizes out the tax treatment supporting this system. Wyden-Bennett and Ryan-Rivlin look nice on paper but are far more radical than what's on the table."

Rationalizing the tax treatment supporting the system would have been treating health insurance purchased by an individual the same as insurance purchased through a company for tax purposes, i.e. giving an individual the same tax deduction for health insurance that a company received or eliminating the tax deduction for the company purchased insurance so that both are purchased with after tax income.

This isn't what happened. Instead we have a complicated subsidy and exchange system for the individual market and a "firewall" that supposed to prevent people with existing company provided insurance from bleeding over into the Federal government subsidies. Once this happens, the CBO estimates on the cost savings are out the window and the ACA will not in fact reduce the deficit without substantial changes to the level of subsidies provided.

@jnc4p:
"Rationalizing the tax treatment supporting the system would have been treating health insurance purchased by an individual the same as insurance purchased through a company for tax purposes, i.e. giving an individual the same tax deduction for health insurance that a company received or eliminating the tax deduction for the company purchased insurance so that both are purchased with after tax income."

You really don't understand why it's important in our healthcare system to provide preferential tax status to insurance provided through an employer vs. individual insurance purchase?

Shouldn't learning how and why our current system works/doesn't work be a prior step to talking about what changes should be made?

@cummije5 wrote:
"... projections of what the government thought that medicare was going to cost when it was initially enacted and graph it alongside of what it actually has cost. "
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And just for more clarity, what it would have cost us if the elderly had to buy insurance from monopolies and the costs associated with treating the elderly in emergency rooms.
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Maybe it will cost more than proposed. So what. The true cost of not doing it is being represented in the double digit increases in premiums over the last 20 years. Much like the housing bubble, that simply can't continue without a crash. If you thought losing a home was bad, try losing your health care when you have kids.

While the Republicans are busy in their efforts to repeal the health care reform, supporters of the law should make known to the people where the Republicans are lying. Since the financial aspect is what is considered the Achilles' heel of the reform, Democrats and supporters of the law who are in a position to influence the people should work on this aspect.
Another thing that the Dems should resolve with the people is their view that the reform is the government's means to invade the citizens lives and get more money from them.

"In the meantime, in at least a few states, claims for medical care covered by the "high-risk pools" are proving very costly, and it is an open question whether the $5 billion allotted by Congress to start up the plans will be sufficient."

"In the spring, the Medicare program's chief actuary predicted that 375,000 people would sign up for the pool plans by the end of the year. Early last month, the Health and Human Services Department reported that just 8,000 people had enrolled. HHS officials declined to provide an update, although they collect such figures monthly, because they have decided to report them on a quarterly basis."

In other words, the funding wasn't enough, even though enrollment is currently at 2.13% (yes, that decimal is in the right place) of what was expected.

"Not when the excise tax kicks in, which exposes hitherto shielded income dollars to taxation. The success of ACA depends on this one key lynchpin--if lawmakers lose their nerves and repeal this then I agree the whole system falls apart."

belegoster,

I think that, at least initially, this reduces the quality of employer health plans in order to stay outside of the excise tax boundaries.

I'm not precisely sure if the law would allow this one way or another, but my expectation would be that if possible, firms would increase deductibles and at the same time increase HSA contributions. I'm not sure if the HSA contributions are also hit by the tax, or if there is any other way around it.

Another issue is that $10,200 for an individual and $27,500 for a family are pretty thresholds. Some of that is probably expected inflation, but wow. The employer tax exclusion value at those precise levels (right before the excise tax hits) would be the same as the total cost for good individual and family policies just a few years ago.

I'd also be concerned that one of the first populations likely to be hit with this tax are unions given their great health benefits

Maybe it's just me, but isn't the health care system a failure if costs get high enough so that a large number of insurance plans are well beyond that threshold? Another related question - does the excise tax get charged in the exchange? If it does, I think you'll see families in the $120k - $150k gross income range screaming for subsidies if their health plans are in the mid $30k range. Likewise an individual earning $50k - that's a good income, but a $15k health plan would decimate it.

I feel the more I learn about reform, I have more questions than answers.

"Disclosure: I'm actually from Singapore"

You make a lot of good points about your system, and would agree that there is much in it that isn't acceptable to American conservatives. In addition to the personal responsibility portion, I think the low overall costs are also appealing to them - I believe last time I checked, health spending in your country was 3.8% of GDP vs ~17-18% here.

@Lynne5
"Anyone with a head for numbers that isn't rooted in liberal spin can tell you the CBO numbers are fictional. The real cost is far, far, far beyond CBO spin." If that were the case, Eric Cantor would have used this to his advantage instead of saying less substantive stuff like, beyond the 10-year window. Oh wait, both Eric Cantor's and your argument to the facts and missing figures are pretty much baloney. It sounds like you're dismissing facts you find too hard to agree with.

"If anyone wonders why newspapers are in decline just read the space given to journalist who insist on reporting to their political bent." I hear it was due to the internet and the alternative news sources one can get on the internet, not the expansion of the op-ed piece.

"Love the 'number have a liberal bias' quip!"
I really would like to you see produce the numbers for us.

As to the CLASS Act, CBA says that it should have a surplus of around $70B this decade and a bit less than that the next. After that, it will supposedly cost the federal government a net couple billion a year.

I have the impression that that few billion/year would be paid for by the interest savings due to the short term gains, that may be incorrect. But the bottom lines to me are:
(A) The overall PPACA, including the CLASS Act, reduces the deficit by on the order of a trillion per decade starting in the mid 20s.
(B) The CLASS Act itself also saves a great deal of money for the states, who would otherwise be footing the bill for much of what CLASS will cover. As such, from the 'broad government' perspective, CLASS is a big overall deficit boon.

"As to the CLASS Act, CBA says that it should have a surplus of around $70B this decade and a bit less than that the next."

No, there is no long-term surplus. The CLASS Act is designed to have actuarially equivalent premiums and benefits, meaning over the life of the program it is completely deficit-neutral, the premiums received and benefits paid are exactly equal. There is a surplus in early years because you are not eligible for benefits until you have the coverage for 5 years. It is completely false to say it has a smaller effect in later years.

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I have the impression that that few billion/year would be paid for by the interest savings due to the short term gains
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That's not correct. Like I said above, the CLASS Act is completely neutral to the budget.

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(A) The overall PPACA, including the CLASS Act, reduces the deficit by on the order of a trillion per decade starting in the mid 20s.
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Estimating the costs beyond 10 years is useless, there is far too much uncertainty about the what can happen with the economy and legislation to make confident estimates that far into the future, that is why the CBO scores things for 10 years.

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(B) The CLASS Act itself also saves a great deal of money for the states, who would otherwise be footing the bill for much of what CLASS will cover. As such, from the 'broad government' perspective, CLASS is a big overall deficit boon.
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Quantify it. This is completely baseless. If you're going to make this claim you need to back it up. And regardless, we are trying to quantify the effect on the federal budget.

It's pretty clear you have no evidence to support the claim that the CLASS Act reduces the deficit, which was rather obvious since it was never designed to do so.

To clarify this a bit for you eggnogfool: the CLASS Act is just the government selling an insurance product. Long-term care insurance is a rather simple product that pays for home health care, nursing home care, etc, after an elderly person can no longer take care of themselves. The nature of the insurance is such that it doesn't typically pay many claims for many years after you buy it. It is similar to life insurance in that regard, and often sold by the same companies. A private company would of course charge a premium such that they earn a profit from it, LTC carriers typically price for a 6-7% profit. But the insurance sold under the CLASS Act is priced to break even, including any interest gains from the early surplus years. This is not my opinion, this is right from the CBO:

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"The estimated premiums are calculated to be adequate for the program to remain solvent for 75 years, taking into account the interest income that would be
generated on unspent balances in the program’s trust fund. (Because most enrollees would not receive benefits for many years, the fund would accumulate significant
balances in the early years of the program.)"
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When you sell LTC insurance you have to set aside those early year surpluses to pay for the claims in later years. They're not doing so, instead claiming that those premiums can be used to fund other entitlements. And because they use that surplus to buy treasuries, they estimate that it would fact lose a small amount of money from having to pay interest on money they're getting any return on. to quote the CBO:

"Typically, enrollees
pay premiums for many years before some of them become disabled and qualify for
benefits. Private issuers of long-term care insurance finance benefit payments from their reserve of accumulated premium receipts and the income they derive from investing those premiums. Similarly, the Secretary would invest CLASS program premium receipts in federal securities and would incorporate that expected income into calculations of appropriate premiums to charge. However, trust fund income from investments in federal securities would be an intragovernmental transfer within the federal budget. As a result, from a budget scorekeeping perspective, the CLASS program would inevitably add to future deficits (on a cash basis) by more than it reduces deficits in the near term, even though the premiums would be set to ensure solvency of the program"
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The CLASS Act does not reduce the deficit, so claiming that PPACA reduces the deficit is completely false.

The money that you save by refinancing every month can be sensibly used to repay your unique loan or to upsurge your savings. Do not forget to search online for "123 Mortgage Refinance" they found 3.17% rate for me.

Anyone with a head for numbers that isn't rooted in liberal spin can tell you the CBO numbers are fictional. The real cost is far, far, far beyond CBO spin.
If anyone wonders why newspapers are in decline just read the space given to journalist who insist on reporting to their political bent.

Love the "didn't know number had a liberal bias" quip!

Posted by: Lynne51
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You put me in a pickle. I have a head for numbers. Now I have two choices:

1. Listen to the CBO, their numbers, their charts, their graphs, their extensive research, their logic, their argument that OBAMACARES saves over a trillion dollars.

2. Listen to you, with no numbers, no graphs, no logic, no evidence, nothing but your opinions that the cbo is wrong.

let's wait till the health care law is over 100 years old, then we can say it is as confusing as when it was passed. once the health care law is over 100 years old then we can say it is not relevant. or better yet, 100 years from now, the congress can begin a new session by reading the health care law so tv reporters and washington post bloggers can ask the question: "is this a gimmick?"

Klien's claim that the existing health care spending bill "cuts enough spending and raises enough taxes to more than pay for itself, both in the first 10 years and in the second 10 years." is absurd. There is no way to accurately predict the costs of such a huge spending bill twenty years into the future. Even the projection for the first ten years is suspect because there are so many details that are left to regulators to fill in later.

Sen. Paul Ryan just stated that the Repubs submitted the health care bill to the CBO and had them include all accounting gimmicks in their scoring. It came back costing over 700 billions in the 1st 10 years. Please blow holes in this. BP

This is so mind boggling who can tell what actually will happen. I can tell you the outcome already, any cuts made and services retracted will be those which the poorest of the poor desperately require. The mindset being "they are defenseless so lets us stomp them". Instead of trying to regulate the health care industry and the insurance industry where the whole problem lies lets blow smoke so you have no idea where,
what and why is. Just think if insurance had no deductibles, no depreciation and no out of pocket expenses for the insured....then insurance would have to actually earn their money like the rest of us but as it is it is legal theft of funds. Same with health care, different terminology. An average ER visit is $800.00. Time spent to earn this is approximately 12 minutes to 25 minutes. Initial Doctor visit.....$125.00 average. Time 4 minutes to 12 minutes. Of course the patient must spend up to one hour to get the 12 minutes allotted but what the hey they are expendable. Anything the government does with health care will not help the common man in any way. Until health care has to provide a service in accord with cost worthiness health care will always be out of reach for the common man. Period.

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